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Home My WebLink About11-09-12 (2) J 1505610105 REVS 1500 Fx taz-rr, tF,> i~ PA Department of Revenue Pennsylvania OFFICIAL USE ONLY Bureau of Individual Taxes °""""`»`°`"`"`"°` County Code Year File Number PO BOXZBo6ot INHERITANCE TAX RETURN - - -- Harrisbur PA t tab-o6ot RESIDENT DECEDENT °Z ~ i`Z yG ~ ENTER DECEDENT INFO MATION BELOW Social Security Number ' Date of Death MMDOYYYY Date of Birth MMDDYYYY C>Jrr~- ~a -/~(03 01/25/12 '12/18/1927 Decedents Last Name Suffix Decedent s First Name MI Yawger Florence 'Z' (If Applicable) Enter Surviviing Spouse's Information Below Spouse's l ast Name _ Suffix Spouse's First Name MI Spouse's Social Secunty NJmber THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW OD 1. Original Return '. O 2. Supplemental Return O 3. Remaintler Reurn (Date of Death '~ O 4. Limited Estate '~. O Prior to 12-13-82) 4a. Future Interest Compromise (date of O 5. Federal Estate lax Return Required OD 6. Decedent Died Testae death after 12-12-82) (Attach Copy of Will) O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Trust.) O 9. Litigation Proceeds F~eceived I O 10. Spousal Poverty Credit (Date of Death O 11. Election to Tax under Sec. 9113(A) _ Between 12-31-91 and 1-1-95) (Attach Schedule O) ......~.~..r~nvcn i - i nis sec I IUN MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAx INFORMATION SHOULD BE DIRECTED TO: Name y q' Daytime Telephone Number Andrew C. Sheet , Es lire 717-697-7050 ^~ i C7 _ ~~ '~, REGISTER OF WI ` r t ~ ~ ~I§E ONLY "_ First Line of Address '~ 127 South Market Street Second Line of Address '~ P.O. Box 95 City or Post Office ~'. Mechanicsburg ~ ~ r ~ U .., r ~ ~ I r ~ n r~ '. t ". r-~ ,~ ,. -n i ~ ~..~ _C ' "; b r r ~-- `'~ Q c - L T7 _State ZIP Code DATE FILED P.A 17055 Correspondent's a-mail add ess:andreWC.Sheely~COti1C8St.net Under penalties of perjury, I declar that I have examined this return, including acwmpanying schedules and statements, and to the best of my it is true, correct and complete. De laration of preparer other than the personal representative is based on all informaticn of which preparer h SIGNPTURE OF PE~2SQN RESP NSIBLE FOR/tjLING RETURN r.nn Ise r ent, Exe 804 Lancelot Ave., Mechanicsburg, PA 17055 t ~ SIG RE OF R T AN REPRESENTATIVE occc -__--_--~~/~ _ Andrew C. Sheely, E 7 South Market St., P.O. Box, Mechanicsburg, PA 17055 PLEASE USE ORIGINAL FORM ONLY - II! Side 1 15056101105 1.ri05610105 J REV-1500 EX (FI) Decedent's Name: YBWgef, FIO(QfICe Z. RECAPITULATION 1505610205 Decedent's Social Security Number o~~ aa- ~z~3 1. Real Estate (Schedule A) ..... ......... ......... ................. 1 _ _.. .. 2. Stocks and Bonds (Schedule B) .......... ........ .................. 2 ... _. _ , 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages and Notes Receivable (Schedule D) ....... .................. 4 __ $15,193.64: 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5 s. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property $25,795 47 (Schedule G) O Separate Billing Requested........ 7. ', $4Q,989.11 8. Total Gross Assets (total Lines 1 through 7) ............................. 9. 9 $2 953.41 9. Funeral Expenses and Administrative Costs (Schedule H).......... $15,674 44 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule p ..... ......... 10. t1 $18,627.85 11. Total Deductions (total Lines 9 and 10) .. ......... ......... 12 $22,361 26 12. Net Value of Estate (Line 8 minus Line 11) ......... .......... 13. Charitable and Governmental BequestslSec 9113 Trusts for which ' an election to tax has not been made (Schedule J) .... ........ ......... 13. $22,381.26' 14. Net Value Subject to Tax (Line 12 minus Line 13) ........................ 14. ' TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers and=r sec. 9116 15. (a)(1.2)X.0 _.. ._..._ ... .... _. ts. Amount of Line 14 ~=-able $1,006.25 $22,361.26' 18 at lineal rate X .045 . _.... .._.. ....... _.... _.... ._ 17. Amount of Line 14 taxable 17 at sibling rate X .12 _.... ..... _. _... 1s. Amount of Line 14 taxable 18 ' at collateral rate X .15 _.... _....... __ _. $1,008.25, 19. TAX DUE .... ......... ....... ......... 19. _. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610205 1505610205 J REV-1500 EX (FI) Page 3 Files Num M. Decedent's Complete Address: °j ~" ~~ - 4'G/ DECEDENT'S NAME Florence Z Yawger STREET AnnRF'SS 804 Lancelot Avenue rir. _...___ _,. -..__. --- Mechanicsburg srnrE PA - zIPZIP---- -_ - 17055 tax rayments and Clredits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments (1) $1,006.25 A. Prior Payments I B. Discount 3. Interest ~ Total Credits (A + B) (2) 4. If Line 2 is greater than Line 1 ~+tine 3, enter the diRerence. This is the OVERPAYMENT. (3) 1.23 Fill in oval on Page 2, line 2~ to request a refund. (4) 5. If Line 1 + Line 3 is greater tha~ Line 2, enter the diRerence. This is the TAX DUE. (5) $1,007.48 Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWEf~ THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROP RIAT E BLOCKS t. Did decedent make a transfer and: a. retain the se or income of the property transferred ................................................................................... ' Yes ....... ^ No . b. retain the ght to designate who shall use the property transferred or its income ..................................... ....... ^ . c. retain a re ersionary interest ........................................................................................................................ ...... ^ • d. receive th promise for life of either payments, benefits or care? .............. 2. If death occu ed after Dec. 12, 1982, did decedent tmnsfer property within one year of death without receiv ng adequate consideration? .............. 3. Did decedent} r~wn an "intrust tor" or payable-upon-death bank account or security at his or her death? ........ ...... ^ id decedent ~ wn an individual retirement account, annuity or other non-probate property, which contains a be eficiarydesignation? ............................................................_............._............... ~ ^ IF THE ANSWER TO ANY OF HE ABOVE QU3EmSTmIONS ISYES,10U MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. ~.~ ~ ~i~=~: ~ >~~ ~ ,'-j,',!1°t i t~, ttn.{hq'!.{~^t~~i. ~x ,i tyr 3'>n ¢i .i? ~ .. ,.'z a n t ;': , ,r :: , , Yi For dates of death on or after July 1994, and before Jan 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 PS §9116 (a) (1 1) (i)]. For dates of death on or after J~n. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S. §9116 (a) (1.1) (ii)]. The st lute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are sell applicably even if the surviving spouse is the only beneficiary. For dates of death on or after July I1, 2000: • The tax rate imposed on the nit value of transfers Rom a deceased child 21 years of age or younger at death to or for the use of a natural parent, an adoptive parent or a stepparen of the child is 0 percent [72 P.S. §9116(a)(1,2)]. The tax rate imposed on the net ivalue of transfers to or for the use of the decedent's lineal beneficiades is 4.;i percent, except as noted in [72 P.S. §9116(a)(1)). • The tax rate imposed on the n t value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116(a}(1.3}]. A sibling is defined, under Section 9102, as an indi~dual who has at least one parent in common with the decedent, whether by blood or adoption. REVn5o8 EX+ (u-io) { ~ ' pennsylvanna DEPARTMENT OF REVENUE INHI°RITANCE TA% RETURN RESIDENT DECEDENT ESTATE OF: Florence Z. Yawger 1. ~ Members 1st SCHEDULE E CASH, BANK DEPOSITS & MISC. PERSONAL PROPERTY FILE NUMBER: 21-12-401 Include the proceeds of litigation and the date the proceeds were received by the estate. ~ --- property jointly owned with right of survivorship must be disclosed on Schedule F. DESCRmTrnm VALUE AT Account #315872-00, Principal as of date of death $2,121.43, accrued interest $.32 2. Members 1st Ch~cking Account #315872-11,Principal as of date of death $1,224.97, accrued interest $.00 3. Members 1st Inv~stmentAcct#315872-05, Principal as of date of death $8,346.31, accrued interest $1.48 4. Decedent's 2011 income Tax Return 5. Bank of America,~ccount #0000 4546 5432 TOTAL (Also enter on Line 5, Recapitulation) $ If more space is needed, use additional sheets of paper of the same size. $2,121.75 $1,224.97 $8,347.79 $2,400.00 $1,099.13 15,193.64 "°"°°" Date Axount Establ' 315672-00 had Principal Balance at 10/13/2007 ate of Death $2 121 43 . Accued Interest to , . of Death. $ 32 Total Principal and A . ed Interest $2 121 75 Name of Joint Owner , . None AC T: AaouM Number/S 315872 11 Date AcoouM Establia ed 10/13/2007 Principal Balance at D to of Death $1 224 97 Accued Interest to D , . e of Death $ 00 Total Principal and A ed Interest $1224 97 Name of Joint Owner None 1 TM CCOUNT: AxouM Number/S 315872-08 Data AxouM Establis ed 10/13/2007 Principal Balance at D to of Death $8 346 31 Accrued Interest to Da , . of Death $148 Total Principal and A rued Interest $8 347 79 Name of Joint Owner I , . None -- -. - it --- .._. I MBA Sts'E p'ER^A CRE N ~ ~~~ ~ ~ 11 Danielle A. Kllne '~ Lending Insurance Support Specialist !, it ~i Mareh 3, 2012 Estate of FLORENCE I NN YAWGER Date of Death; 01/25l20~ 2 Social SecurHy Numbe .059-221763 5000 Louise Drive P.~ . Box 40 Mechanicsburg Pennsylvatva 17055 800 , ( ) 283-2328 wwwmembetslstoxg Ban~COfAmerica ~~ Bank of America, N.A. r P.O- Box 25118 Tampa, GL 336223118 ^ 4,ii~ulV~I~P~ldl4ulirl~i~l~h~l~~h~h~lllih~~~h~~lh~li !1D 12 29 0 0005 435 4 000 004159 114401 SP 0.365 FLOf~ENCE Z YAWGER 804I'ILANCELOT AVE MECENANICSBURG, PA 17055-5737 Page 1 of 3 Statement Period 11-22-]1 through 12-21-11 B140HPPH 14 Number of checks enclosed: 0 Account Numbet: 0000 4546 5432 Our Online Banking service allows you to check balances, track account activity and more. With aline Banking you can also view up to 18 months of this statement online and even turn off delivery of your paper statement. Enroll at www.bankofamerica.com. Interest Checking FLORENCE Z YAWGER Account at a Account Number I 0000 4546 5432 Beginning Balance on 122-11 $ 1,099.12 Annual Percentage 'Yield Earned this Statement Depostts and Other dditions + 0.01 period: 0.01% Eading Balance on 12- 1-11 $ 1,099.13 Interest Paid Year to Date: $0.12 I '~ Interest Checking Additions Interest Earned 12-21 0.01 Total Deposits and Other Additions $0.01 ~~, Recr=~ REV-1510 E%+ (08-09j ~° ~~~' ~' pennsylvania SCHEDULE G DE°nerneNr of nEVe"ue INTER-VIVOS TRANSFERS AND '""E"'T""`E r"x RET~"" MISC. NON-PROBATE PROPERTY FIESIDENT DECEDENT ESTATE OF Florence Z. 'Yawger FILE NUMBER 21-12-401 This schedule rust be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM DESCRIPTION OF PROPERTY NUMBER ~"cwoer"ex neor~EmaNSFEaeE, raeF aEUnoNSn~rrooeceoenr arvo DATE OF DEATH rive Dare FraaNSrea. arraca a Corr ormE Deco roF Feac esrare VALUE OF ASSET "/a DF DECD' ' INTEREST S EXCLUSION 1F a t. KSKJ Life Annuity, Polir;y #08-119833 - 5 year certain $5,7222 0 100% 1 rrucaem~ As of the date of death,Idecedent's beneficiaries (children) Pam Butler, Kim Parent and Richard Yatatger were entitled to receive quarterly payments of I $953.70 for an addition I six quarters through the fixed date of May 28, 2013. I 2. KSKJ Life Annuity, Polidy #08-119976 - 5 year certain $20 073 2 7 , . 100% As of the date of death, ecedent's benefciaries (children) Pam Butler Kim , Parent and Richard Ya ger were entitled to receive quarterly payments of $3,345.54 for an additio al six quarters through the fixed date of June 28 , 2013. TOTAL (Also enter on Line 7, Recapitulation) $ If more space is needed, use additional sheets of paper of the same size. TAXABLE VALUE $5,722.20 $20,073.27 25, 795.47 REV-1511 EX+ (1D-09j ~ Pennsylvania DEPggTMENT OF gEVENUE INMERITNNCE TpX RETURN 0.ESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Florence Z. Yawger 21-12-401 _~ _. Decedent's debts must be reported on Schedule I. A. FUNERAL EXPEN~ES: 1' Malpezzi Funeral Home 2. MechanicsburgPresbytedanChurch s. Parthemore Fuheral Home a. Blossom Shop{flowers 6. Hilton Head Presbyterian Church e. ADMINISTRAT[Vl~ COSTS: i. Personal Represl'entative Commissions: Name(s) ¢f Personal Representative(s) Klm Denise Parent street Ad~ress 804 Lancelot Avenue c;ry Me hanicsburg Year(s) Ctummission Paid: $150.00 $375.00 $151.81 $279.26 $400.00 $500.00 __ State PA zIp 17055 Z~ AttorneY Fees: }4/'2d~e Ca] GShCa°~/Y f59UX /~(/ 3. Family Exemptioh: (If decedent's address is not the same as claim/ant's, attach explanation.) Claimant f Street Address _ City _ '~,, ___ State Relationship of Claimant to Decedent __ 4. Probate Fees: ~'~, 5. Accountant Fees 6. Tax Return Prep~rer Fees: ~ Rental car expenses associated with funeral a. Postage s. Filing Fee ~ o. Reserves to con~lude Estate administration, final tax returns and accounting If more space is needed, use additional sheets of paper of the same size. ZIP TOTAL (Also enter on Line 9, Recapitulation) ~; $500.00 $133.50 $137.59 $11.25 $15.00 $300.00 Z, 953.41 RECEIPT FOR PAYMENT GLENDA FARMER STRASBAUGH Receipt Date: 4/03/2012 Cumberland County - Register Of Wills Receipt Time: 10:36:48 One Courthouse S uare Receipt No.: 1069367 Carlisle, PA 1713 YAWGER FhORENCE Z Estate File N .. 2012-00401 Paid By Remar~s: KIM Y. PARENT HEA --------------I----- ----- Receipt Distribution ----- -------- ------- ---- Fee/Tax Descri tion Payment Amount Payee Name PETITION LTRS TEST WILL 60.00 CUMBERLAND COUNTY GENERAL FUN RENUNCIATION 15.00 10 00 CUMBERLAND COUNTY GENERAL FUN SHORT CERTIFIC TE JCS FEE . 20.00 CUMBERLAND CUMBERLAND COUNTY COUNTY GENERAL GENERAL FUN FUN AUTOMATION FEE 23.50 - - - 5.00 BUREAU OF RECEIPTS CUMBERLAND COUNTY & CNTR GENERAL M.D FUN Check# 1078 Total Received ----- $133.50 ..... .... $133.50 REV-1512 E%f (12-08J ~ ~pennsylvania SCHEDULE I DEPARTMENT OF gE~ENUE DEBTS OF DECEDENT '"NERIT"NCE T"x wET"R" MORTGAGE LIABILITIES & RESIDENT DECEDENT LIENS ESTATE OF FILE NUMBER Florence Z. Yawger 21-12-401 ___ ___....,~.,.~ ,~~„~.~ u. um aanie sae. NOTICE OF CLAIM COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION ESTATE OF FLORENCE Z. YAWGER, DECEASED No. 21-12-401 To the Clerl~ of the Orphans' Court Division: Kin I ly enter the claim of Sarah A. Todd Memorial Home in the amount of $15,473.69 against the bove-captioned Estate. The claim is a priority claim under 20 Pa.C.S.A. §3392(3) for nursing acility services within six (6) months of the date of death. The Decedent, who resided at S ah A. Todd Memorial Home, died on January 25, 2012. Written notice of said claim was ven to Andrew C. Sheely, Esq., counsel for the estate of Florence Z. Yawger, at 127 South Mazk t Street, Mechanicsburg, PA 17055 on June 12, 2012. Claimant: Sazah A. Todd Memorial Home 1000 West South Street ', Cazlisle, PA 17013 Respectfully Submitted, ', Latsha Davis 8c McKenna, P.C. Date: G, ~~ ~ ~ ~ ~~ ~_ Steve ~ Montresor ', Attorney No. 74244 1700 Bent Creek Boulevazd, Suite 140 Mechanicsburg, PA 17050 Phone: (717) 620-2424 ', Fax: (717) 620-2444 smontresor@ldylaw.com 149694v1 .~ ~,g~ ------ ___ GEORGE BRANSCUM, MD FED. ;-p.g 4 PRONE ~---.~~, _~ CARLISLENPpR17015-9337 StMement pare: ~/21J12 Provider: ~ ~.... ------_._ .____AHOUNT DUE . AMOUNT EN I,.111...IIL,..I,L.GI,ld.1.~~fdl~l.,dF1....I.,1=ILa 532 LORENCE YAWGER ' ~----'-- ---- ~` ------- ECHALN CSBU GA R 17055-5737 --' ~ -_- i i - ---+-- .. .. PLE4SE~pETAOH aNOgND RETURN TOP SE -- ' - _ CTION WITH YOU. tl.4KE ?AYi~AENT TO: ~~~Nas~ GEORGE BRANSCUM, ND CODE D?"= "- _ 017301 2 BAL. FO -'----- 01730/.2; PATIENTRPY~ ~CHECK2/21/11 .00 12/29/ 1 PATIENT' PYl1T _ CHECK -8.33 ~ 12/29/ 1 MEDFCARE PAY~SENT -8:33 112/28/ 1 MEDICARE ADJUSTyENT 12/29/11 HEDICARE PAYMEi1T 783.7 12/13/11 :99307 MEDICARE ADJUSTMEH7 ~ 02/1411 c 32 SUBSEQUENT NH YFSFT i 02/1411 AEDFCARE PAYNENT 50. U0 YOUR INSURANCE C per. HEDTCARE ADJUS7?!EN'#-; -33.31 ~ HAS PAID ITS PORTION. -8.36 401.1' 01124/1 THE BALAN~ IS YOUR RESPORSIBILITY. 99307 31 SUBSEOU E-'R-NH YISIT + -- - ~- ~ f - - ~ - ____ i I - - - i - _: I _ ~ THANK YOU FOR YOUR RECENT-PAYMENT. - cuRREnrr. 33 - I.00 .00 j . 00 : . 00 THE AMOUNT SHOD;.! --- __ ----__ - - a~En so oars ~ OVER 90 DArS ~ oyER ~~ ors 1N THE EATIENT COLUf~Ht. 8.33 02 / 21 / 12 16 66 ~ iS DUE NQVd. ------ • ` sraTEMENT DaTE - __ 532 ~ mueni., a~~ti1 -ems rre _- :- --- _. _ -- 6EOp6E 8-.. -: - ~ -SYil1ENT5~ ACCOUNT NUMBER I ~a °f wiumn T* c ; ~ . -_ _ _ -= r : - - - - s~ ~ ~~ ~ F~D.# 429842285 PNONE NO.: (304) 264-8570 i GEORGE gRANSCUM, MD - 77 NELSON DR. - CARLISLE PA 17015-9337 , - "'c, Statement Date: 04/24/12 ~ru~~~ru~~~n nr~~r~r~r~r~un~~m~~r~nr~~ur~~rn~~~rrr~ ; Provider: GEORGE BRANSCUM, MO ' ~ ~ ~ ~~ AMOUNT DUE 49.71 X004428/1-}S 18--8 1 ~nr~~~ur~~~ru~r~u~r~u~r~r~nr~u~~r~m~~~rnr~u~r~~n~ FLORENC YAWGER 804 LAN ELOT AVE MECHANI SBURG PA 17055-5737 I MAKE ?AYMENT TO: GEORGE BRANSCUM, MD JIAG OSI DATE ~~ PP.O EDURAI ; i LOC ; Patlerlt Insurance Pem CODE i ~I RE ERENCE NAME ~pEi CHARGES/PAYMENTS/ADJUSTMENTS ~, ' ~ ~ BAL. FORWARD AS OF 02/24/12 --~-'-- 8.33 '---50.0[ 103/20/12'' ' I I MEDICARE ADJUSTMENT -8.6; I 'I, I i I i I i ', _ . _ I I 'Youraccbunt is gettingg seriously past due. Please call i'f t ere is a problerh dr if you have any questions. 41 .38 , OQ ' 8.33 ' . DO ~ . 00 -THE AMOUNT SHOWN -- ------- INTHE PATIENT COLUMN 49.71 .00 CURRENT OVER 30 DAV ''. OVER 60 DAYS ~~ OVER 90 DAYS ;OVER 120 DAYS ~ ]S DUE NOW. PATI'cNT - i\S a t\D J! 04/24112 ~ _ _ 16.66 ~, _ $32 '~ This b II is due upon receiot The pa ien s respons ble to pzy any and a I charges soon the 'PahenY' column. The charges shown m t~e'ms~rnce Pending ~ ol~mn hale Deer i~ec STATEMENT DATE ~VTD PATIE T PAYMENTS ~- ACCOUNT NUMBER the patients insurance company or the patient's bet If The patient is always raspons ole o ^~.e GEORGE BRANSCUM, MD ~.. -~ payment of any and all services rentleretl which are rot paitl b/ ~,nsu arce. Until fur;he~ notice. __ _ I ~OUNT NUMBER ~-~~I`~- AMOUN"f ENCLOSED I 532 $ ~~ Millennium Pharmacy Systems 100 E Kensinger Dr Bldg 120 Suite 500 Cranberry Twp, PA 16066 1-866 - 466 - 7779 Opt. 4 INVOICE DATE: April 16, 2012 Balance Due: $142.71 PARENT, KIM 804 LANCELOT AVENUE MECHANICSBURG PA, 17055 YAWGER, FLORENCE Account Number STMH1955 Pharmacy Location: ' ~ MECH 2 Please Detach here and Return Top Portion with Payment Re: Facility: Account #: Pharmacy Loc: ~~ P~~~E'f1t1tUCY~ Invoice Date: 4/16/2012 Balance Due: $142.71 Last Payment: $152.55 Last Payment Date: 11/9/2011 ACCOUNT OVERDUE Dear Valued Miennium Customer, Millennium Ph acy Systems is committed being the best pharmaceutical supplier in the industry. In order to mainta this standard and keep our records up to date we; have noticed that there is an outstanding balan e showing on your account. Please remit pa ent today to keep your account in good standing. If financial circumstances make it difficult to remit ayment in full please contact us to set up a suitable payment plan. We also accept --- Visa and MasterC d. Please make checks payable to Millennium Pharmacy Systems. If you feel there is~any discrepancy in regards to this balance please feel free to contact us and ask to speak with a cone tion specialist. We look forward ~o working with you and appreciate your assistance in helping to resolve this outstanding balan~e. Thank you for your anticipated cooperation. Sincerely, Collections Depat~lent Millennium Pharm~cy Systems Tel: (724) 940 - X490 Fax: (866) 228 - 267 _L YAWGER, FLORENCE Sarah Todd NC STMH1955 MECH You can now pay your Bill Online!! www.MPSRx.com ~ Contact ~ Pay your bill REV-1513 E;(+ (OS-10) ~ Pennsylvania SCHEDULE DEPARTMENT OF REVENUE INMERRANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: Florence Z. Yawger I 1. 2. 3. II 1. NAM AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRI UTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] Kim Denise Parent, 804 Lancelot Avenue, Mechanicsburg, PA 17055 Pam Annette B Idler, 31 Wells East Drive, Hilton Head, SC 29926 Richard Lee Yawger, 2353 North Avenue, Scotch Plains, NJ 07076 ENTER DOLLAR NON-TAXABLE [ A. SPOUSAL D 1. FILE NUMBER: 21-12-401 KtLAI1UNSHIY IU DtCtDtNI T HMVUIVI UK ~tlHNt Do Not list Trustee(s) OF ESTATE Daughter Daughter I Son 33 1/3% rest, residiue R remainder 33 1/3°/D rest, residiue & remainder 33 1/3% rest, residiue & remainder FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. UNDER SECRON 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: it B. CHARITABLE AID GOVERNMENTAL DISTRIBUTIONS: TOTAL OF II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ If more space is needed, use additional sheets of paper of the same size. O~.iG~NA~ i, -(.05 LAST WILL AND TESTAMENT OF FLORENCE Z. YAWGER Prepared By: LAW OFFICES FERRENE & ASSOCIATES, P.A. 75 Pape Avenue Hilton Head Island, S.C. 29928 (803) 785-5184 LAST WILL AND TESTAMENT OF FLORENCE Z. YAWGER I, FLORENCE Z. YAWGER the undersigned TESTATRIX hereby declaze that I am a residern of Hil~n Head Island, South Carolina and do hereby make, publish and declaze this as and to be my Last Wi 1 and Testamern, hereby revoking atry and all former Wills and Codicils. ~. I authorize my Personal Representative to pay from the residue of my estate all of my debts as allowed in the administration of my estate, the expenses of my last illness and funeral, all of the a uses of the administration of my estate including a reasonable fee for my Personal Representativ and without contribution or reimbursement from any person, all inheritance, legacy or estate taxes, ' lading collateral taxes on property passing by this Will. B. My immediate family consists of the following persons: KIM ENISE PARENT DAUGHTER PAM TTE BUTLER DAUGHTER RIC LEE YAWGER SON and except as ~isted, I have no deceased children with lineal descendants surviving them. AR ~. I give to my beloved daughter, PAM ANNETTE BUTLER ,the real property, with improv etrts thereon, known as Unit 9102 Newport Horizomal Property Regime, Hilton Head Island, Beauf rt County, South Cazolina to be hers absolutely, if she shall survive me. If she shall not survive me by thirty days, then I give the real property to the children of PAM ANNETTE BUTLER, (DAVID E RETT BUTLER, II, DANIELLE LAUREN BUTLER, KATELYN LEE BUTLER) in equal shares, haze and share alike per stirpes. E D. The rest and residue of my property, both real and personal, if arty, I give to my children in eq 1 shares, shaze and share alike per stirpes. Should one of my children not survive me, then his or be share should be divided equally between his or her child or children surviving at the time of my death. E. If any share or property hereunder becomes distributable to a beneficiary who has not a the age of twenty-one (21) years or if arty real property shall be devised to a person who has not a the age of twenty-one (21) yeazs at the date of my death, then such shaze or property shall imm ety vest in such beneficiary, but notwithstandingthe provisions herein, my Personal Representati a acting as Trustee shall retain possession of such share or property in trust for such beneficiary til such beneficiary attains the age of twenty-one (21), using so much of the net income and principal of such share or property as my Personal Represernative deems necessary to provide for the proper pport, medical care, and education of such beneficiary, taking imo consideration to the extent my Pe oral Represerrttive deems advisable arty other income or resources of such beneficiary or his or her parents known to my Personal Represeruative. Arty income not so paid or applied shall be FERRENE & ASSOCIATES, PA 75 POPE AVENUE, HILTON HEAD ISLAND, SC 29928-4709 Tekphone:843/785-5184 Fax:843/84~331b 1 acxmrtulated and added to principal. Such beneficiary's share or property shall be paid over, distributed and conveyed to such beneficiary upon attaining age twenty-one (21), or if he or she shall sooner die, to his or her Personal Representatives or administrators. Whenever my Personal Representative determines it appropriate to pay arty money for the benefit of a beneficiary for whom a trust is create(i hereunder, then such amours shall be paid out by my Personal Representative in such of the folio ways as my Personal Representative deems best: (1) directly to such beneficiary; (2) to the legallyappointed guardian of such beneficiary; (3) to some relative or friend for the care, support, an education of such beneficiary; or, (4) by my Personal Representative using such amoums for such beneficiary's care, support, and education. My Personal Representative as Trustee sh 11 have with respect to each shaze or property so retained all the powers and discretion conferred updn it as Personal Representative. E E. I appoin my three children, ISM DENISE PARENT, PAM ANNETTE BUTLER, d RICHARD LEE YAWGER as my Personal Co-Represernatives to execute this, my last Will Testament as the Personal Representative thereof, but if arty one of such Personal Co- Represenativ shall be unable or unwilling to serve in that capacity, i# shall be acceptable for arty one of them or o of them to serve as my Personal Representative and they shall act without bond and without the irvenion of arty court to the extern that such bond and court intervention in arty process may be waiv by me under the laws of the State of South Carolina. My Personal Representative(s) shall have full pow r to sell, convey and encumber, without notice or confirmation, arty assets of my estate, real, persona or mixed, at such prices and terms as to either may seem just; to advance funds and borrow none , secured or unsecured from atry source, including arty source with which my said Personal Represenativ may have arty business affiliation; to mortgage or pledge estate property; to select any part of the es to in satisfaction of arty partition or distribution hereunder, in kind, in money or both. Such powers ay be exercised whether or not necessary for the administration of my estate, provided however that all evens, the same shall be reasonably exercised, and provided further that arty funds advanced to o funds borrowed from any person or firm with which or whom my Personal Represenative has arty bus' s affiliation shall be advanced or borrowed only upon reasonable commercial terms. C G. All references to children and descendatrts shall include adopted children. Unless I, I RENCE Z. YAWGER, the TESTATRIX, sign my name to this instrumern this 7th day of 7 , 2005, and being first duly sworn, do hereby declaze to the undersigned authority that I sign and ex this instnrmen as my last will and that I sign it willingly (or willingly direct another to sign forme , that I execute it as my free and voluntary act for the purposes therein expressed, and that I am eightee yeazs of age or older, of sound mind, and under no constrain or undue influence. some other and inert rs appazern from the coruext, the plurals include the singular and vice versa, and culine, feminine and neuter words aze interchangeable. liy inert and not by mistake or inadvertence, I make no provisions except as herein provided, for atry ofmy children, whether named herein or her fter born or adopted, not for the descendarns of any child who does not survive me. FLORENCE Z. Y ~ FERRENE & ASSOCIATES, PA 75 POPE AVENUE, HILTON HEAD ISLAND, SC 29928-4709 Telephone: 843/7$5-5184 Fac 843/8423326 We, Otto W. Ferrerle, Jr. And Amy Inglis ,the witnesses, sign our names to this instrument, being first duly sworn, and do hereby declaze to the undersigned authority that the testator signs and executes this instrument as HER last will and that SHE signs it willingly (or willing duects another to sign for HER) and that each of us, in the presence and hearing of the TESTATRIX, hereby sigru this will as witness to the TESTATRIX'S signing, and that to the best of our knowledge the TESTATRIX is eighteen yeats of age or older, of sound mind, and under no constraint or undue influence. STATE OF S{l)UTH CAROLINA COUNTY OIL BEAUFORT Sub bed, sworn to and acknowledged before me by FLORENCE Z. YAWGER, the TESTATRif~and subscribed and sworn to before me by Otto W. Ferrene, Jr. and Amy Inglis witnesses, this 7th day of January, 2005. Notary Publi for South Cazolina My Commis on Expires:2/28/2011 ~WOTARY "~ ' PUBLIC ~o se FERRENE & ASSOCIATES, PA 75 POPE AVENUE, HILTON HEAD ISLAND, SC 29928709 Telephone: 843/785-5184 Fsx: 843/84~332(r NOTES ('These Note pa es are provided for the convenience of the TESTATRIX o~ pages is not bring upon the Personal Represetuative as to the dis y' Any entry upon these TESTATRIX lsh to insure dispositions in accordance with any Nppt~tt~,~ h tit be made, aofonnal Will change is !required and our Firm should be contacted as soon as possible for the appropriate changes). r1;RRENE & ASSOCIATES, PA ~-" 75 PPE AVENUE, HILTON HEAD ISLAND, SC 29928-4709 Telephone: 543/785-5184 Fax: 843/542-3326 4